Various fixation methods are available for intra-articular distal radius fractures, depending on column involvement. Some rely solely on ulnar hook plates, while others use specific “extra distal” plates that address both columns. To date, no comparative studies have evaluated these techniques. This study compared the fixation by ulnar hook plate combined with one or two percutaneous screws (Group 1) in the radial styloid with extra distal plates fixing both columns (Group 2). Functional outcomes were hypothesized to be similar, whereas complication rates were expected to differ.

A single-center retrospective study was conducted, including distal radius fractures operated between May 2022 and March 2025. The primary endpoint was functional outcome at 1 year (pain, range of motion, grip strength, and QuickDASH score). Secondary endpoints included radiographic quality of reduction (≤2 mm articular step off) and complication rate. Patients were followed at 1, 3, 6, and 12 months.

Forty-six patients were included: 24 treated with the Group 1 construct and 22 with Group 2 fixation. According to the AO classification, the Group 1 comprised 10 C1, 11 C2, and 3 C3 fractures; the Group 2 had 9 C1, 9 C2, and 4 C3 fractures. At one year, range of motion, grip strength, and QuickDASH scores were comparable between groups. However, complications were significantly more frequent in the extra distal plate group, mainly due to flexor tendon irritation or rupture, resulting in a higher reoperation rate.

Both fixation methods achieved equivalent functional recovery. Nonetheless, the ulnar hook plate combined with one or two percutaneous screws fixation demonstrated a safer profile, with fewer tendon-related complications and reoperations. When the radial styloid is intact, limiting implant volume beyond the watershed line may reduce flexor tendon morbidity.

Ulnar hook plate fixation achieves similar function with fewer tendon-related complications, supporting a “less volume distal to the watershed line” strategy when the styloid is not comminuted.

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